59224D - Black

�,CAMA / ❑ DREDGE & FILL
"ENERAL PERMIT
Previous permit#
-]New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rrized by the State of North Carolina, Department of Environment and Natural Resources Ono()
I SA NCAC
Coastal Resources Commission in an area of environmental concern pursuant to ,
it Name
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bi
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,Rules attached.
Project Location: County _jYyy ,�y 1LP L
al�
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1 1'Yll 1'l(.1 sl-a �-
Street Address/ State Road/ Lot #(s)
I &(J, State ZIP Z
Fax # ()
Subdivision
iedAgent dG1►11
CvS
City ZIP
CW y7�W PTA —ES ❑ PTS
1�''''
%ne'# (I� River Basin W n
❑ OEA ❑ HHF ❑ IH - UBA ❑ N/A
�� (nat�l
Adj. Wtr. Body CO-V\ ir
yes / no PNA yes / no Crit.Hab. yes / no
-.
Closest Maj. Wtr. Body YV 1/V
4 Project/ Activity (.wYl5t1 y L i ru
Dck) length LO
n(s)
pier(s)
ength
ember
ad/ Riprap length
rg distance offshore
iax distance offshore
:hannel
jbic yards
imp
'use/ Boatlift
Bulldozing
Amp 3x Its
(Scale: I �r
ling permit may be required by:
--) 11
' OWh (i i V (LV\ [S i f ❑ See note on back regarding River Basin
I--d-. — , _ _I .. ! I , I t _ .. I — . 1 lI - I . 1 I ., i . . I , . 1 4, .

El
lift
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I

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
I certify that I have authorized (agent) 44-a2n (Y,zZ4r to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
a(oic- ;
at (my property located at)
This certification is valid thru (date)
5/a, // aj
roperty Owner Signature
Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
901
Address of Property: C ! J LA,.-o <tY,tee+ V C12M..--ld�-� r
(Lot or Street #, Street or Road, City & County) nn /
Applicant phone #: q/0 St) S'- �'" — Mailing Address:
r. ate , /vc- anqC'y
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
16 �0 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact-dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Propprt Owner Informatio
Si na ure
DIIGAa4( V' Ond Ir 1-4n�111 4Cr-
Print or Type Name
(Riparian Property Owner Information)
Signature
t o.,
Print or Type Name
a3o —Ta
Mailing Address
Mailing Address

W,
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: t�,�ae, l Vi a', L % � 1--Ck
Address of Property: Cx t �l c%n�+o �-"M2! Ck=942-U1S)o &2_ e-- ,
(Lot or Street #, Street or Road, City & County)
Applicant phone #: �%l� - S� S —�g 1(oMailing Address:0A�
� d��+•o�J( S
r/c a?Lf(
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
.A-�
I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
waive the setback, you must initial the appropriate blank below.)
.PiN_ 961 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro y wner Information) (Ripari n Property Owner 71frmation)
Signature Signature
aI"I ✓ Flo.- A/,4cr "►.� L. a„J1�-I�,r V. cA
Print or Type Name Print or Type Name
Mailing Address Mailing Address

m
' 1 6CO` w(Z,<\ \
SSG• w cA

plicant: A Ckoa i s Undo, Ra c k-
!e:
5%l-4 JI
Permit #. 9g2-2- ` tD
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
TYPE
itat Name Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tern impacts)
FINAL7fiinal
(AnticipDISTURB
disturb
Excludes any
restoration and/or
temp impact
amount
i
Dredge ❑ Fill ❑ Both ❑ Other
1
I
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
9 X6 _ 1121
9,1)= qI,

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card fo you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Blake D. and Joann H. Yokley
230 Town Run Lane
Winston-Salem, NC 27101
�� %Nme)
B. ived by (PrintC. Date f
i
D. Is delivery address different tom item 1? ❑
If YES, enter delivery address below: ❑ No
Z
�`.- .S.�,,erv``ice Type
ertified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
2. Article Number
4. Restricted Delivery? (Extra Fee) ❑ Yes (transfer from service label) 7009 1680 0000 2206 8955
PS Form 3811, February 2004 Domestic Return Receipt
102595-02-M-1540
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Walter L. and Earlene V. Ward
1570 Westmont
Asheboro, NC 27203
A.
X
U Agent
.ni ❑ Addressee
B. Received b (Prnted Nam) C. Da e of elivery
EAo�E V . .ni�el) s
D. Is delivery address different from item 1? ❑ es
If YES, enter delivery address below: ❑ No
3. Se_- e Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
�4. Restricted Delivery? (Extra Fee) ❑ Yes
Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transfer from service label) 7009 1680 0000 2206 8962
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540